Prior authorization support
Prior authorization is where clinical intent meets payer administration, and it is one of the heaviest recurring burdens in a practice. We take on the requirement checks, submissions, follow-up calls and expiry tracking so treatment plans move forward without your clinical staff living in payer portals.
Industry context — published figures about US healthcare, not Sure Rev Solution results
Prior authorizations completed per physician per week, on average.
AMA, 2025 Prior Authorization Physician SurveyPhysician and staff time absorbed by prior authorization each week, on average.
AMA, 2025 Prior Authorization Physician SurveyOf surveyed physicians employ staff working exclusively on prior authorization.
AMA, 2025 Prior Authorization Physician SurveyWhat we take on
Authorization work is procedural, repetitive and unforgiving of small omissions. That makes it well suited to a dedicated team running a consistent process.
Requirement identification
Before anything is submitted, we establish whether authorization is actually required — for that payer, that plan, that procedure or service code, that place of service and that provider. Requirements differ between product lines under the same payer name, and assuming they don't is a common source of both wasted effort and missed requirements.
Documentation coordination
We work with your clinical team to assemble what the payer's criteria call for: history and duration of the condition, conservative treatments already attempted, objective findings, functional impact and the clinical rationale for the requested service. Incomplete clinical support is a leading cause of adverse determinations and avoidable peer-to-peer reviews.
Submission and payer communication
Requests go through whichever channel the payer requires — portal, electronic transaction, phone or fax — and we maintain the follow-up cadence needed to keep them moving. Reference numbers, representative names and dates are logged so nothing depends on recollection.
Status tracking to determination
Every open request is tracked with the payer, the date submitted, the expected turnaround and the next follow-up. Pending requests are chased rather than left in a queue, and determinations are recorded against the account so scheduling and billing both work from the same information.
Unit and expiry monitoring
Approvals are usually finite: a number of visits, sessions or units, valid for a defined window. We monitor consumption against the approval and flag re-authorization needs before treatment reaches the limit — the difference between a continuous course of care and an interrupted one.
Adverse determinations
When a request is denied, we obtain the specific reason, identify whether it is a documentation gap, a criteria mismatch or an administrative error, and support the appropriate next step — resubmission, appeal or a peer-to-peer review scheduled with your provider.
Authorization rarely fails loudly.
It fails as a request nobody chased, an approval that expired, or a unit count nobody was watching — and it surfaces weeks later as a denial for a service already delivered.
Requests that stall in a queue
Submitted, acknowledged, and then untouched. Without an owner and a follow-up schedule, a pending request can sit until the patient's appointment arrives and the practice has to choose between delaying care or accepting the risk.
Approvals that quietly expire
An authorization valid for 60 days or 12 visits will lapse mid-course if nobody is tracking it. The visits still happen; the payment often doesn't.
Mismatch between what was approved and what was billed
Approval for one code, procedure or level of care and a claim submitted for another produces a denial even though the authorization exists. Reconciling the approval against the submitted claim closes that gap.
Retroactive requests
Some payers permit retroactive authorization in defined circumstances; many do not. Identifying the requirement during eligibility verification is what keeps a practice out of this position in the first place.
Specialty considerations
Authorization pressure looks different by specialty: continuing-care reviews in behavioral health, visit authorizations and plan-of-care certification in physical therapy, and procedure-level coverage criteria in pain management.
Let's build a healthier revenue cycle.
Tell us where your revenue cycle is under pressure right now. We'll walk through what's happening, what we'd take on, and whether working together makes sense for your practice.